Patients with peripheral arterial disease (PAD) undergoing percutaneous coronary intervention (PCI) are at high risk for adverse cardiovascular events. Trends over time in outcomes with advances in PCI and medical therapy are unknown. We evaluated 866 patients with PAD in the National Heart, Lung, and Blood Institute (NHLBI) Dynamic Registry undergoing PCI according to treatment eras: the early bare metal stent (BMS) era (Wave 1: 1997(Wave 1: -1998, the BMS era (Waves 2 and 3;1999and 2001-2002 n=339), and the drug-eluting stent (DES) era (Waves 4 and 5: 2004 and n=347). We compared in-hospital and 1-year outcomes by recruitment era. Inhospital coronary artery bypass graft surgery (CABG) rates were significantly lower in the later eras (3.9%, 0.9%, 0.6%, early BMS, BMS, and DES eras respectively, p trend =0.005), and an increasing percentage of patients were discharged on aspirin, beta blockers, statins, and thienopyridines (all p trend <0.001). Cumulative 1-year event rates in patients with PAD in the early BMS era, BMS era, and DES era of death were 13.7%, 10.5%, and 9.8% (p trend = 0.21), of myocardial infarction (MI) were 9.8%, 8.8%, and 10.0% (p trend = 0.95), and repeat Corresponding Author: Elizabeth M. Holper, MD, MPH, University of Texas Southwestern Medical Center, Division of Cardiology, 5323 Harry Hines Blvd, Dallas,, Elizabeth.Holper@UTSouthwestern.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. p=0.001). In conclusion, despite significant improvements in medical therapy and a reduction in repeat revascularization over time, patients with PAD who undergo PCI have a persistent high rate of death and MI.
NIH Public Access
KeywordsPeripheral arterial disease; stents; catheterization In unselected patients undergoing percutaneous coronary intervention (PCI), the adverse outcomes of death and myocardial infarction (MI) have improved over time [1][2][3]. However, trends over time in outcomes specifically of patients with peripheral arterial disease (PAD), given advances in PCI including the use of drug-eluting stents (DES) and more aggressive medical therapy, are not known. Thus, utilizing the National Heart, Lung and Blood Institute (NHLBI) Dynamic Registry, we compared the in-hospital and one year outcomes of patients with PAD undergoing PCI across three different treatment eras: the early bare metal stent (BMS) era, the BMS era, and the DES era.
MethodsThe specific methodology and characteristics of the NHLBI Dynamic Registry have been reported previously [2]. In brief, data were collected on approximately 2,000 consecutive patients undergoing PC...